<style>
    .layui-iconpicker-body.layui-iconpicker-body-page .hide {
        display: none;
    }
    .select_a {
            color: #009688;
            padding: 2px;
            margin: 2px;
            border: #009688 1px dashed;
        }
</style>
<link rel="stylesheet" href="__STATIC__/plugs/lay-module/autocomplete/autocomplete.css?v={$version}" media="all">
<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
                <div class="layui-form-item">
            <label class="layui-form-label">订单号</label>
            <div class="layui-input-block">
                <input type="text" id="order_num" name="order_num" class="layui-input" lay-reqtext="请输入订单号" placeholder="请输入订单号" value="{$row['order_num']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">护理类型id</label>
            <div class="layui-input-block">
                    <div class="layui-form-select" style="width: 200px">
                        <div class="layui-select-title">
                            <input type="text" data-name="name" class="layui-input aselect" placeholder="请输入护理类型id" data-url="/admin/ajax/ajaxselect" autocomplete="off" data-contentid="nursing_lang_id" data-table="nursing_lang" data-relationship="id">
                            <input name="nursing_lang_id" type="hidden" value="">
                            <i class="layui-edge"></i>
                        </div>
                        <dl id="nursing_lang_id" class="layui-anim layui-anim-upbit"><dd lay-value="" class="layui-select-tips" style="text-align: center"><i class="layui-icon layui-icon-loading layui-icon layui-anim layui-anim-rotate layui-anim-loop">请选择</i></dd></dl>
                    </div>
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">被护理人姓名</label>
            <div class="layui-input-block">
                <input type="text" id="cover_pepo_name" name="cover_pepo_name" class="layui-input" lay-reqtext="请输入被护理人姓名" placeholder="请输入被护理人姓名" value="{$row['cover_pepo_name']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">被护理人性别</label>
            <div class="layui-input-block">
                    {foreach $alldata['field']['cover_pepo_sex']['option'] as $key=>$vo}
                    <input name="cover_pepo_sex" value="{$key}" type="radio" title="{$vo}"  {if $key==$alldata['field']['cover_pepo_sex']['default']}checked=""{/if}>
                    {/foreach}
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">是否住家</label>
            <div class="layui-input-block">
                <input name="is_live" class="switch" value="1" type="checkbox" lay-skin="switch" lay-text="是|否" {if $alldata['field']['is_live']['default']==1}checked=""{/if}>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">联系电话</label>
            <div class="layui-input-block">
                <input type="text" id="phone" name="phone" class="layui-input" lay-reqtext="请输入联系电话" placeholder="请输入联系电话" value="{$row['phone']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">具体地址</label>
            <div class="layui-input-block">
                <input type="text" id="address" name="address" class="layui-input" lay-reqtext="请输入具体地址" placeholder="请输入具体地址" value="{$row['address']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">购买时间</label>
            <div class="layui-input-block">
                <input type="text" name="purchase_time" class="layui-input datetime" id="purchase_time" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">服务天数</label>
            <div class="layui-input-block">
                <input type="text" id="days" name="days" class="layui-input" lay-reqtext="请输入服务天数" placeholder="请输入服务天数" value="{$row['days']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">支付金额</label>
            <div class="layui-input-block">
                <input type="text" id="money" name="money" class="layui-input" lay-reqtext="请输入支付金额" placeholder="请输入支付金额" value="{$row['money']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">用户</label>
            <div class="layui-input-block">
                    <div class="layui-form-select" style="width: 200px">
                        <div class="layui-select-title">
                            <input type="text" data-name="name" class="layui-input aselect" placeholder="请输入用户" data-url="/admin/ajax/ajaxselect" autocomplete="off" data-contentid="uid" data-table="user" data-relationship="id">
                            <input name="uid" type="hidden" value="">
                            <i class="layui-edge"></i>
                        </div>
                        <dl id="uid" class="layui-anim layui-anim-upbit"><dd lay-value="" class="layui-select-tips" style="text-align: center"><i class="layui-icon layui-icon-loading layui-icon layui-anim layui-anim-rotate layui-anim-loop">请选择</i></dd></dl>
                    </div>
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">被护理人年龄</label>
            <div class="layui-input-block">
                <input type="text" id="age" name="age" class="layui-input" lay-reqtext="请输入被护理人年龄" placeholder="请输入被护理人年龄" value="{$row['age']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">服务费金额</label>
            <div class="layui-input-block">
                <input type="text" id="service_money" name="service_money" class="layui-input" lay-reqtext="请输入服务费金额" placeholder="请输入服务费金额" value="{$row['service_money']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">平台费金额</label>
            <div class="layui-input-block">
                <input type="text" id="platform_money" name="platform_money" class="layui-input" lay-reqtext="请输入平台费金额" placeholder="请输入平台费金额" value="{$row['platform_money']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">结束时间</label>
            <div class="layui-input-block">
                <input type="text" name="end_time" class="layui-input datetime" id="end_time" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">联系人姓名</label>
            <div class="layui-input-block">
                <input type="text" id="contact_name" name="contact_name" class="layui-input" lay-reqtext="请输入联系人姓名" placeholder="请输入联系人姓名" value="{$row['contact_name']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">订单类型</label>
            <div class="layui-input-block">
                    {foreach $alldata['field']['types']['option'] as $key=>$vo}
                    <input name="types" value="{$key}" type="radio" title="{$vo}"  {if $key==$alldata['field']['types']['default']}checked=""{/if}>
                    {/foreach}
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">保姆选项</label>
            <div class="layui-input-block">
                <textarea name="nanny_options" class="layui-textarea" placeholder="请输入保姆选项">{$row['nanny_options']|default=''}</textarea>
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">护工</label>
            <div class="layui-input-block">
                    <div class="layui-form-select" style="width: 200px">
                        <div class="layui-select-title">
                            <input type="text" data-name="name" class="layui-input aselect" placeholder="请输入护工" data-url="/admin/ajax/ajaxselect" autocomplete="off" data-contentid="staff_people_id" data-table="staff_people" data-relationship="id">
                            <input name="staff_people_id" type="hidden" value="">
                            <i class="layui-edge"></i>
                        </div>
                        <dl id="staff_people_id" class="layui-anim layui-anim-upbit"><dd lay-value="" class="layui-select-tips" style="text-align: center"><i class="layui-icon layui-icon-loading layui-icon layui-anim layui-anim-rotate layui-anim-loop">请选择</i></dd></dl>
                    </div>
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">员工是否接单</label>
            <div class="layui-input-block">
                    {foreach $alldata['field']['is_meet']['option'] as $key=>$vo}
                    <input name="is_meet" value="{$key}" type="radio" title="{$vo}"  {if $key==$alldata['field']['is_meet']['default']}checked=""{/if}>
                    {/foreach}
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">是否已续费</label>
            <div class="layui-input-block">
                    {foreach $alldata['field']['is_renew']['option'] as $key=>$vo}
                    <input name="is_renew" value="{$key}" type="radio" title="{$vo}"  {if $key==$alldata['field']['is_renew']['default']}checked=""{/if}>
                    {/foreach}
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">支付状态</label>
            <div class="layui-input-block">
                    {foreach $alldata['field']['pay_state']['option'] as $key=>$vo}
                    <input name="pay_state" value="{$key}" type="radio" title="{$vo}"  {if $key==$alldata['field']['pay_state']['default']}checked=""{/if}>
                    {/foreach}
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">订单状态</label>
            <div class="layui-input-block">
                    {foreach $alldata['field']['state']['option'] as $key=>$vo}
                    <input name="state" value="{$key}" type="radio" title="{$vo}"  {if $key==$alldata['field']['state']['default']}checked=""{/if}>
                    {/foreach}
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">状态</label>
            <div class="layui-input-block">
                <input name="status" class="switch" value="1" type="checkbox" lay-skin="switch" lay-text="开启|关闭" {if $alldata['field']['status']['default']==1}checked=""{/if}>
            </div>
        </div>

        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>
<script>
    var parameter = '{$parameter|raw|default=""}';
</script>